P07-04 A systematic review of key interventional elements in international exercise referral schemes

Abstract Background With the first initiatives dating back to the 1990s, the past two decades have seen a rapid increase in the use of exercise referral schemes (ERS) worldwide. Despite the accumulating evidence on their effectiveness, there are currently no international guidelines available to inform the design of such interventions. The key elements and processes employed vary both within and between countries. This systematic review aims to address this frequently overlooked topic by identifying elements that are predominant in international ERS. Methods Scientific databases (PubMed, Scopus) and grey literature sources were systematically searched. In order to collect the information relevant for understanding and visualizing all ERS models, a broad spectrum of document types was considered eligible for inclusion, i.e. randomized controlled or pragmatic trials, cohort studies, case-control studies, case series, case reports, qualitative studies, economic evaluations, mixed designs, policy documents, and official governmental reports. We extracted data on scheme components, contents, and main actors involved in scheme delivery. Cross-functional flowcharts were employed to facilitate comparison between different ERS designs: Firstly, the collected data were visualized in flowcharts indicating the pathway a patient follows from beginning to end of an individual ERS. Secondly, elements that appeared more frequently across all included ERS were identified. Results Preliminary results identified 18 models of ERS that were eligible for data analysis, including Green Prescription (New Zealand), Hreyfiseðill (Iceland), National Exercise Referral Scheme (Wales). Program designs ranged from short advice by a primary healthcare professional to physical activity prescription and/or further referral to affiliated health professionals. The prevailing actors involved in scheme delivery were physicians, nurses, physiotherapists, training experts, physical activity providers, and coordinators. Seven predominant elements emerged from the comparison between ERS designs: assessment, counselling, individualized physical activity recommendations, written prescription, behavior change techniques, support person, and follow-up. Conclusions To the best of our knowledge, this is the first study that takes a closer look at the design characteristics of ERS across the world. Our preliminary results indicate that there are seven key elements. The contribution of these elements on the effectiveness of ERS needs to be explored in future research.


Issue/problem
The law of modernization of the French health system promoted in 2016 have authorized any attending physician to prescribe a program of physical activity suitable for patients with a chronic disease. The health benefits of active living habits are now well known but too few physicians have seized this prescription of Adapted Physical Activity (APA). Description of the problem APA teachers have come to complement the health professions to deliver APA, and sports clubs have improved their organization to welcome patients who have adequate physical condition. Regional systems have been deployed to receive patients, using such resources. The 'Médicosport Santé' guide provides relevant guidance for patients according to physical and/or sporting activities (PSA) and diseases. The medical prescription for APA must therefore become a practical reality for chronic disease patients, guaranteeing a lasting change in lifestyle through more active behavior. Experience from the Grand Est country The commitment of certain French Regional Health Agencies, has led certain regions to offer regional systems, as the ''Prescri'mouv'' plan in the Grand Est country, allowing a step forward to best support the patient from the medical prescription to regular and lasting practice. After medical prescription, patients are directed to an APA professional or physiotherapist, for an initial evaluation and orientation towards one of the three types of care: autonomous practice, labeled structure, specific support.

Lessons
The main objective of APA is to fight against a sedentary lifestyle. With an adequate physical condition, physical activities and sports are to be considered in order to help patients with chronic disease, sources of pleasure and lasting health benefits. New actors have come to strengthen health professionals, and through 'Sport Santé' concept, sports clubs have organized themselves to welcome patients.

Main messages
Adapted physical activity is the keystone in the fight against sedentary lifestyle. New players have come to strengthen health professionals, sports clubs have organized themselves to welcome of and best support patients with chronic disease. The challenge is for physicians to take hold of this medical Abstract citation ID: ckac095.104 P07-04 A systematic review of key interventional elements in international exercise referral schemes

Background
With the first initiatives dating back to the 1990s, the past two decades have seen a rapid increase in the use of exercise referral schemes (ERS) worldwide. Despite the accumulating evidence on their effectiveness, there are currently no international guidelines available to inform the design of such interventions.
The key elements and processes employed vary both within and between countries. This systematic review aims to address this frequently overlooked topic by identifying elements that are predominant in international ERS. Methods Scientific databases (PubMed, Scopus) and grey literature sources were systematically searched. In order to collect the information relevant for understanding and visualizing all ERS models, a broad spectrum of document types was considered eligible for inclusion, i.e. randomized controlled or pragmatic trials, cohort studies, case-control studies, case series, case reports, qualitative studies, economic evaluations, mixed designs, policy documents, and official governmental reports. We extracted data on scheme components, contents, and main actors involved in scheme delivery. Cross-functional flowcharts were employed to facilitate comparison between different ERS designs: Firstly, the collected data were visualized in flowcharts indicating the pathway a patient follows from beginning to end of an individual ERS. Secondly, elements that appeared more frequently across all included ERS were identified.

Results
Preliminary results identified 18 models of ERS that were eligible for data analysis, including Green Prescription (New Zealand), Hreyfiseôill (Iceland), National Exercise Referral Scheme (Wales). Program designs ranged from short advice by a primary healthcare professional to physical activity prescription and/or further referral to affiliated health professionals. The prevailing actors involved in scheme delivery were physicians, nurses, physiotherapists, training experts, physical activity providers, and coordinators. Seven predominant elements emerged from the comparison between ERS designs: assessment, counselling, individualized physical activity recommendations, written prescription, behavior change techniques, support person, and follow-up.

Conclusions
To the best of our knowledge, this is the first study that takes a closer look at the design characteristics of ERS across the world. Our preliminary results indicate that there are seven key elements. The contribution of these elements on the effectiveness of ERS needs to be explored in future research.

Background
Physical activity on prescription (PAP) -like schemes, have been documented to encourage sustained increases in the levels of physical activity of populations. Although proven effective, these PA promotion schemes have only been implemented high-income countries (eg. Northern/Western Europe). The aim of this study was to explore the opportunity to test PAP (related) schemes in Romania, a developing country.

Methods
In the timeframe May-June 2018 we conducted a transversal study, using an online questionnaire adressed at general practitioners (GPs) in the county of Cluj. The instrument Abstract citation ID: ckac095.106 P07-06 Physical activity promotion in cancer patient: opinions and practices of health professionals Yoric Petitfrè re 1 , Jé rô me Rompen 1 , Marc Cloes 1 , Alexandre Mouton 1 1 Motor Sciences, University of Liè ge, Liè ge, Belgium Corresponding author: ypetitfrere@uliege.be Background Literature suggests that health professionals (HPs) can play an important role in promoting physical activity (PA) in cancer patients (Jones et al., 2004). This study had three purposes: (1) analyzing HPs' knowledge and opinion about PA for cancer patients; (2) examining practices, barriers and roles that they identify when considering PA promotion in their patients; (3) determining factors that may enhance practices in this field.

Methods
This study was designed in two phases and took place in Wallonia, Belgium. The first phase was qualitative: 12 HPs were interviewed about their experiences with PA in cancer patients. Then, in the second (and quantitative) phase, an online survey was created based upon the results of the first phase and upon the relevant literature. We sent this secondphase survey to professional organizations, hospitals and medical health centers and received 68 responses.

Results
In both phases of the study, HPs seemed to be aware of the benefits of PA for cancer patients and considered that they have to play a role in promoting PA in that specific population. However, only 25% (n = 17) of HPs were familiar with the official PA guidelines. According to our results, HPs discuss the topic of PA with more than 7 out of 10 patients (7.11 AE 2.61). Lack of time and lack of knowledge about PA were identified as barriers to PA promotion. Finally, other relationships that may help to explain the role of HPs in PA promotion were uncovered: clinicians who used more information (e.g. PA benefits) (p = >0.001), exercised referrals (p = 0.012), and prescribed PA (p = 0.007) had higher intervention rates.

Conclusions
Our findings suggest that improving HPs' knowledge about PA guidelines and how it can be proposed to cancer patients could help them to promote PA and to encourage their patients to communicable diseases (NCDs). Today more than 70 hours of therapeutic PA are weekly offered. Nevertheless, the organization of these PA is incomplete and not enough patients benefit from it. Description of the problem Sustainability of privately organized courses is challenging. Despite a governmental financial support, the organization of PA offer remains mainly based on the idealism of a limited number of volunteers. However, this kind of commitment is disappearing and jeopardizes a correct offer of therapeutic PA. Only a minority of physicians are referring their patients on a regular basis and only a minority of them are engaging in an active lifestyle.

Results
A project was launched in 2013 to compile, monitor and promote the therapeutic PA offered by different associations. As a result of this project, six associations created a sport